Right ventricular injury and pulmonary embolism: The perils of deep intramyocardial left anterior descending artery dissection in off-pump coronary artery bypass grafting

• Main Authors: Biswarup Purkayastha, Lalit Kapoor, Vikash Toshniwal, Devraj Kumar
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2021-01-01
• Series: Annals of Cardiac Anaesthesia
• Subjects: deep intramyocardial left anterior descending coronary artery; exploring left anterior descending coronary artery; pulmonary embolism; right ventricle injury; trendelenburg position
• Online Access: http://www.annals.in/article.asp?issn=0971-9784;year=2021;volume=24;issue=1;spage=99;epage=101;aulast=Purkayastha
• ISSN: 0971-9784

An inadvertent vent in the right ventricle (RV) resulted during dissection of a deep intramyocardial left anterior descending coronary artery (LAD), during off-pump coronary artery bypass grafting (OPCAB), led to pulmonary artery air embolism and hemodynamic instability, requiring conversion to cardiopulmonary bypass (CPB) prior to repair. This required a special maneuver in positioning the patient to identify the RV injury and prevent the pulmonary air embolism.